Provider Demographics
NPI:1659624682
Name:PLAYA ADVANCE SURGICAL INSTITUTE LLC
Entity Type:Organization
Organization Name:PLAYA ADVANCE SURGICAL INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HAPPER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:310-600-5846
Mailing Address - Street 1:4712 ADMIRALTY WAY
Mailing Address - Street 2:#930
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6905
Mailing Address - Country:US
Mailing Address - Phone:310-600-5846
Mailing Address - Fax:
Practice Address - Street 1:5450 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90094-2002
Practice Address - Country:US
Practice Address - Phone:310-600-5846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical